Frontal White Matter Hyperintensity Is Associated with Verbal Aggressiveness in Elderly Women with Alzheimer Disease and Amnestic Mild Cognitive Impairment

Abstract

Background/Aims: Behavioral and psychological symptoms of dementia (BPSD) are exhibited in most patients with Alzheimer disease (AD). Although white matter hyperintensity (WMH) is often observed with AD, the precise role of WMH in BPSD remains unclear. The current study aimed to identify the impact of regional WMH on specific features of BPSD in persons with mild to moderate AD and amnestic mild cognitive impairment (aMCI). Methods: A sample of 256 female outpatients with AD (n = 217) and aMCI (n = 39) were recruited. We assessed BPSD using the Dementia Behavior Disturbance Scale. WMH and brain atrophy were evaluated using an automatic segmentation program. Regional WMH was evaluated as periventricular hyperintensity (PVH) and deep WMH in frontal, temporal, occipital, and parietal lobes. Results: Whole-brain WMH was associated with verbal aggressiveness. In multivariate analysis, PVH in the frontal lobe was independently associated with verbal aggressiveness after adjustment for brain atrophy and clinical confounders. Conclusion: The current results indicated that PVH in the frontal lobe was independently associated with verbal aggressiveness.

The Longitudinal Assessment of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Alzheimer’s Disease and Their Association With White Matter Hyperintensities in the National Alzheimer’s Coordinating Center’s Uniform Data Set

“…In the longitudinal mixed effect model, baseline WMH load was associated with significantly worse future NPI total scores (p=0.014), NPI irritability severity subscores (p=0.009), and there was a trend for worse future agitation (p=0.058). Our finding that the baseline whole brain WMH load was associated with increased future irritability severity scores supports previous findings (Boublay et al, 2016;Ogama et al, 2018;Misquitta et al, 2019 under review). One study found focal frontal WMH to be associated with verbal aggressiveness in amnestic MCI and AD (Ogama et al, 2018), which supports our current finding of the association between frontal lobe WMH load and worsening agitation and irritability.…”

“…Our finding that the baseline whole brain WMH load was associated with increased future irritability severity scores supports previous findings (Boublay et al, 2016;Ogama et al, 2018;Misquitta et al, 2019 under review). One study found focal frontal WMH to be associated with verbal aggressiveness in amnestic MCI and AD (Ogama et al, 2018), which supports our current finding of the association between frontal lobe WMH load and worsening agitation and irritability. Additionally, this finding echoes the results of Misquitta and colleagues (2019 manuscript under review), wherein they found WMH load to be a significant contributor to the NPI sub-syndrome of hyperactivity, which includes the following: agitation, euphoria, disinhibition, irritability, and aberrant motor behaviour.…”

“…Some studies have related periventricular WMH volumes, especially in the frontal lobes, to hallucinations, depression, and anxiety in patients with AD and Vascular dementia (VaD) (Park et al, 2011;Soennesyn et al, 2012;Starkstein et al, 2009). Focal frontal WMH have also been associated with depression in patients with dementia with Lewy bodies (Barber et al, 1999), apathy in vascular cognitive impairment (Kim et al, 2013), verbal aggressiveness in amnestic MCI and AD (Ogama et al, 2018), and delusions in patients with AD(Cassandra J. M.…”

Interrelationship Differences between Personality Traits in Men and Women

“…Female aggression is considered to differ from male and findings from male samples can not apply to females [7]. Few studies mainly concerned manifestations of aggressiveness in women at various pathological conditions [8] or in women prisoners [7].…”

Volume of white matter hyperintensities increases with blood pressure in patients with hypertension

“…1–3 A close association has been identified between WMHs and dementia and neurodegenerative diseases, including Alzheimer disease and Parkinson disease. 4–6…”